DO NOT RESUSCITATE (DNR) ORDER & ADVANCE HEALTH CARE DIRECTIVE

State of Idaho

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies (Limited/Context-Specific)
7. Risk Allocation
8. Dispute Resolution (Limited/Context-Specific)
9. General Provisions
10. Execution Block (Signatures, Witnesses, Notarization)

1. DOCUMENT HEADER

1.1 Parties

a. “Patient”: [PATIENT FULL LEGAL NAME], DOB [MM/DD/YYYY], residing at [PATIENT ADDRESS].
b. “Attending Physician/Qualified Health Care Provider”: [PROVIDER NAME], Idaho License No. [LICENSE #].
c. “Authorized Representative” (if any): [NAME & RELATIONSHIP] acting pursuant to valid power of attorney/guardianship.

1.2 Recitals

WHEREAS, Patient desires to exercise the right of self-determination regarding health care under Idaho Code Title 39, Ch. 45; and
WHEREAS, Patient specifically intends to decline cardio-pulmonary resuscitation (“CPR”) and authorizes a Do Not Resuscitate (“DNR”) order pursuant to Idaho Code § 39-4512A; and
WHEREAS, Patient seeks recognition of this DNR order by all licensed health-care providers and by Emergency Medical Services (“EMS”) personnel statewide;

NOW, THEREFORE, Patient hereby issues this DNR Order & Advance Directive effective as of [EFFECTIVE DATE] for all purposes permitted by law.

2. DEFINITIONS

For purposes of this Directive, the following capitalized terms have the meanings set forth below. Terms defined herein apply equally to singular and plural forms.

“CPR” – Any combination of chest compressions, artificial ventilation, defibrillation, cardiac drugs, or related procedures intended to restart the heart or breathing.

“DNR Identifier” – A wallet card, bracelet, necklace, or other form meeting Idaho Department of Health & Welfare specifications evidencing this DNR Order.

“EMS” – Emergency medical services personnel licensed or certified under Idaho law who respond to 911 or similar emergency calls.

“Good Faith” – Honesty in fact and the observance of reasonable health-care standards prevailing in the State of Idaho.

“Qualified Health-Care Provider” – A physician, physician assistant, nurse practitioner, or other professional authorized by Idaho law to issue medical orders.

3. OPERATIVE PROVISIONS

3.1 DNR Order

a. No CPR. In the event of cardiac or respiratory arrest, no person shall initiate CPR on Patient.
b. Other Treatments. All treatments other than CPR—including pain management, comfort care, antibiotics, or artificial nutrition/hydration—shall be rendered or withheld in accordance with (i) the Patient’s verbal instructions; (ii) a valid Idaho POST form; or (iii) other applicable advance directives.
[// GUIDANCE: Attach or cross-reference any existing POST, Living Will, or POLST documentation.]

3.2 EMS Recognition

EMS personnel presented with (i) an original of this Directive, (ii) a facsimile or electronic copy reliably identifying Patient, or (iii) a valid DNR Identifier, shall comply with the foregoing DNR Order pursuant to Idaho Code § 39-4512A(5).

3.3 Revocation

a. Patient (or Authorized Representative) may revoke this Directive at any time by:
i. Expressly stating intent to revoke in the presence of a witness or provider;
ii. Destroying all physical copies and DNR Identifiers; or
iii. Executing a superseding written directive.
b. Upon revocation, Attending Physician shall promptly document the revocation in the medical record and notify EMS dispatch, if applicable.

3.4 Conditions Precedent

The Attending Physician’s countersignature in Section 10 constitutes issuance of a lawful medical order enforceable across all health-care settings in Idaho.

4. REPRESENTATIONS & WARRANTIES

4.1 Patient declares being of sound mind and acting voluntarily.
4.2 Authorized Representative (if any) affirms legal authority to act.
4.3 Attending Physician warrants (i) current Idaho licensure and (ii) Good-Faith belief that Patient understands the consequences of this Directive.
4.4 Survival. The representations in this Section survive revocation only to the extent necessary to protect providers acting prior to actual knowledge of revocation.

5. COVENANTS & RESTRICTIONS

5.1 Patient (or Authorized Representative) shall:
a. Maintain at least one readily accessible original or electronic copy of this Directive.
b. Inform close family, caregivers, and health-care facilities of its existence.

5.2 Attending Physician shall:
a. Enter this DNR Order into Patient’s permanent medical record within twenty-four (24) hours of execution.
b. Issue or arrange for a DNR Identifier upon Patient request.

6. DEFAULT & REMEDIES (Limited/Context-Specific)

6.1 Event of Default. Any action in violation of Section 3.1 constitutes a default.
6.2 Remedies. Idaho law affords civil immunity to providers acting in Good Faith reliance on a DNR order; however, willful disregard may subject violators to disciplinary or civil liability.
[// GUIDANCE: Litigation over DNR breaches is rare but possible; preserve contemporaneous documentation.]

7. RISK ALLOCATION

7.1 Indemnification (Provider Protection)

Patient (and Estate) shall indemnify, defend, and hold harmless each Qualified Health-Care Provider and EMS agency that, in Good Faith, withholds CPR in reliance on this Directive, except to the extent of the provider’s gross negligence or willful misconduct.

7.2 Limitation of Liability (Good-Faith Standard)

No provider or EMS agency acting in compliance with this Directive and Idaho Code § 39-4512A shall incur civil or criminal liability merely for withholding CPR.

8. DISPUTE RESOLUTION (Limited)

8.1 Governing Law. All matters arising hereunder shall be governed by the health-care laws of the State of Idaho without regard to conflict-of-law principles.
8.2 Forum Selection, Arbitration, Jury Waiver. Not Applicable to this medical order.
8.3 Injunctive Relief. Because CPR is performed instantaneously, injunctive relief is generally impracticable; however, parties retain all statutory rights.

9. GENERAL PROVISIONS

9.1 Amendment. Any amendment must comply with the execution formalities of this Directive.
9.2 Severability. If any provision is held unenforceable, the remainder shall remain in effect to the maximum extent permitted by law.
9.3 Entire Agreement. This Directive supersedes prior inconsistent DNR instructions, except a later-dated Idaho POST form controls to the extent of conflict.
9.4 Electronic Copies. Photocopies, facsimiles, and bona fide electronic images shall have the same force as the original.
9.5 Counterparts. This Directive may be executed in multiple counterparts, each of which is deemed an original.

10. EXECUTION BLOCK

10.1 Patient / Authorized Representative

I understand the nature of a Do Not Resuscitate order and voluntarily execute this Directive.

10.2 Witnesses (Idaho requires EITHER two adult witnesses OR a notary. Choose one method and strike the other.)

Option A – Witnesses
We declare that the Patient (or Representative) signed or acknowledged this Directive in our presence, appears to be of sound mind, and is not acting under duress or undue influence. Neither witness is (i) the Patient’s health-care provider, (ii) employed by a provider currently treating Patient, nor (iii) entitled to any portion of Patient’s estate.

Option B – Notary Public
State of Idaho )
County of ______) ss.

On [DATE], before me, [NOTARY NAME], a Notary Public in and for said state, personally appeared [PATIENT/REPRESENTATIVE], proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged that they executed the same for the purposes herein contained.

Notary Signature: ____
My Commission Expires: ______
(Seal)

10.3 Attending Physician / Qualified Health-Care Provider

I hereby issue and affirm this Do Not Resuscitate order pursuant to Idaho Code § 39-4512A and have discussed its implications with the Patient or Authorized Representative.

[// GUIDANCE:
1. File the original in the Patient’s chart and provide copies to EMS-dispatching agency, long-term care facility (if any), and family.
2. Consider concurrently completing an Idaho POST form to capture broader treatment preferences.
3. Review at least annually or upon any significant change in Patient’s health status.
]